Revisited. Choices in Deafness: CDC Teleconference August 23, Mary E. Koch, MA, CED

Transcription

1 Choices in Deafness: Revisited CDC Teleconference August 23, 2005 Mary E. Koch, MA, CED Auditory Education Consultant Baltimore, MD 1

2 Hello to each of you I am Mary Koch First a word about: WHO I am and WHY I am talking about this topic 2

3 WHO am I? Graduate of Smith College/Clarke Masters from Gallaudet Taught at Montreal Oral School Helped develop exam for Auditory Verbal Therapists Clinical Director of Helen Beebe Center (Auditory-Verbal) Started CI rehab program at Hopkins On NAD CI Position paper committee Developed Bringing Sound to Life 3

4 WHY am I talking about this topic? I am committed to connecting with children, one at a time And to helping them learn to express themselves and understand others in the most effective way they can. (I speak first as a mother and then as a professional.) AND I am tired of the methodology wars! 4

5 For the first time, we are seeing babies at birth 5

6 How do we counsel the unsuspecting parents? 6

7 What happens when they find out their baby is deaf? 7

8 In steps the professional... What do we say??? 8

9 Counseling Newly Identified Families What is done traditionally? What should we be doing differently? 9

10 Choices in Deafness: Traditionally DO YOU WANT YOUR CHILD: to sign? to talk? We ask Huh? 10

11 Choices in Deafness: Traditionally Auditory Oral? ASL??? Auditory Verbal? Total Communication Cued Speech? 11

12 Counseling Newly Identified Families How might we do it differently? 12

13 Choices in Deafness: Revisited Let s back up a bit And consider first things first 13

14 The Priority Pyramid Cognition The processing of sensation & experience in one s world. 14

15 The Priority Pyramid Communication The transfer of information from one person to another. 15

16 The Priority Pyramid Language Encoding information into mutually understood symbols. 16

17 The Priority Pyramid Modality The manner in which language is expressed. 17

18 The Priority Pyramid Precision The accuracy with which something is expressed. 18

19 cognition communication Language Precision MODALITY What happens when we mix up our priorities??? 19

20 20 cognition communication Language Precision MODALITY EVERYTHING crumbles!

21 The Priority Pyramid Precision Modality Language Communication Cognition The Big 3 21

22 Counseling Newly Identified Families Cognition, communication and language should be the focus of counseling with newly identified families NOT communication methodology. 22

23 Infants with no delays yet. 23

24 Unprecedented opportunity We now can begin intervention with infants with hearing loss BEFORE delays can occur An opportunity that, if missed, is nearly impossible to make up for. 24

25 The Language Iceberg A mountain that nobody sees. 25

26 The Language Iceberg During the first year of life, the neural pathways for language are established first receptively and then expressively. 26

27 The Language Iceberg CAT And then comes the first word 27

28 The Language Iceberg The first word emerges toward the end of the first year evidence of the mountain of neurological foundations that make that single word possible. 28

29 Subsequent sense of urgency Every day that goes by without appropriate intervention, an infant with a hearing loss falls behind in the foundational skills of cognition, communication and language. 29

30 Counseling Newly Identified Families Whatever modality best achieves growth in cognition, communication and language should be used during the first year/s. 30

31 Counseling Newly Identified Families Early intervention should be like a dance following the baby s lead keeping the big three as the focus. 31

32 Counseling Newly Identified Families As the baby develops, learning strengths will be identified and strategies/modalities can be modified to optimize language learning. 32

33 Counseling Newly Identified Families Development of residual hearing, consistent use of amplification, focus on listening, should be emphasized regardless of the primary modality of communication. 33

34 Counseling Newly Identified Families Spoken language can be the goal, however other strategies, including sign can jump start the foundation of language in the early months and years. 34

35 Yeah, but Isn t it true that if a deaf child signs, talk??? he won t talk??? 35

36 Sign Language use may have inhibited spoken language development when access to speech sounds was limited. Pre-Cochlear Implant Era 36

37 Sign Language, when used appropriately, may foster spoken language use when children have full access to speech sounds. Cochlear Implant Era 37

38 Language (in any modality) is the most important factor influencing spoken language. Yoshinga-Itano and Sedley, 2000, Yoshinaga,

39 Questions: Where is language processed in the brain? Is it different for sign vs. spoken language? 39

40 Location. Location. Location....languages with radically different sensory modalities such as speech and sign are processed at similar brain sites. Petitto and Zatorre Scientific American December 6,

41 A language by any other name the brain s language network properly and permanently wires up only when it is exposed to the coherent combination of sound, (sight) meaning, and grammar in any single human language. Lise Elliot What s Going on in There?

42 Our goal must be: (in whatever modality) Language age in months Language age in months Age in months 12 months growth per year 42

43 Often we see Age in months 12 months growth per year but the delay remains 43 Language age in months Language age in months

44 What we don t want to see 6m 1y 1.5 <12 months growth per year 2y Age in months 44 Language age in months Language age in months

45 The ideal Age in months > 12 months growth in a year Language age in months Language age in months

46 Question: If it is the SAME area of the brain for both sign and spoken language, can sign serve as a foundation for the development of spoken language in deaf infants? 46

47 Outcome: Children who receive sign as a springboard in the early months/years, can transition to spoken language with minimal delays in language or speech. 47

48 Pattern of Transition: from Sign to Spoken Language Language competence Use of spoken language Use of sign language Months post-implant Based on pattern demonstrated in research of C. Yoshinaga-Itano. Does not represent actual data. 48

49 What about when a cochlear implant is introduced? 49

50 A cochlear implant is like an acorn. 50

51 Sight Smell Taste Touch Hearing Language Cognition Developmental Asynchrony 51

52 Sight Smell Taste Touch Hearing Language Cognition Minimizing Delays 52

53 LANGUAGE and COGNITION Auditory Skill Development Vision Hearing 53

54 LANGUAGE and COGNITION Vision Hearing 54

55 What about when a child enters school? 55

56 Back to choices Auditory -Verbal Auditory -Oral Cued Speech Total Communication ASL AUDITORY Language Communication Cognition VISUAL 56

57 Choices reframed Fully Auditory Communicator Mostly Auditory Communicator Mostly Visual Communicator Fully Visual Communicator A Av AV VA V 57

58 Who are the children we are serving? A AV Auditory-Verbal/Oral Communicators Auditory + Visual Communicators AV VA Oakland Children s Hospital 58

59 What services are provided? Fully Auditory Communicator Mostly Auditory Communicator Mostly Visual Communicator Fully Visual Communicator A Av AV VA V 59

60 What services are needed? Fully Auditory Communicator Mostly Auditory Communicator Mostly Visual Communicator Fully Visual Communicator A Av AV VA V 60

61 Flexibility is essential Fully Auditory Communicator Mostly Auditory Communicator Mostly Visual Communicator Fully Visual Communicator A Av AV VA V 61

62 What is our responsibility? 62

63 Maintain a sense of URGENCY! 63

64 A sense of urgency! 1. To get an EARLY START. Universal Newborn Hearing Screening (UNHS) gives us the chance to start at birth! 64

65 A sense of urgency! 2. To provide accessible language at an early age. Early use of visual language ALONG WITH SPOKEN LANGUAGE and LISTENING can provide a child with age appropriate language opportunities. 65

66 A sense of urgency! 3. To administer standardized language tests EVERY YEAR. We MUST be accountable by MEASURABLING LANGUAGE PROGRESS each year. We don t know what is working if we don t measure! 66

67 A sense of urgency! 4. To make AT LEAST 12 months language progress in in one year.. This should be the minimum standard for all children. 67

68 A sense of urgency! 5. To aim for MORE than 12 months language progress in 1 year. Our goal needs to be the CLOSING of the LANGUAGE GAP 68

69 A sense of urgency! 6. If something isn t working MODIFY IT! If, based on language testing, the child is not making at least 12 months progress in a year, a different modality should be considered. (The goal of spoken language need not be abandoned, just supplemented!) 69

70 A sense of urgency! 1. To get an EARLY START. 2. To provide accessible language at an early age. 3. To administer standardized language tests EVERY YEAR. 4. To make AT LEAST 12 months language progress in in one year. 5. To aim for MORE than 12 months language progress in 1 year. 6. If something isn t working MODIFY IT! 70

71 In summary 1. Language must take priority over communication modality. 2. Children s learning styles need to be considered in determining which modality will work best. 3. Progress must be measured. 4. Strategies must be flexible. 71

72 Mary E. Koch Thank you! 72

73 Mary E. Koch Questions? 73

74 74